Case Manager

Provides expertise on insurance coverage and common access and reimbursement challenges affecting patients, healthcare providers and clients

The responsibilities include education on access and reimbursement support tools and the participating program, advising healthcare providers (HCP's) and/or patients and caregivers on the benefits and program eligibility for a specific patient, and educating HCP offices on payor processes and procedures

Builds trusted relationships with patients, prescribers, client stakeholders through proactive communication, timely and accurate execution of deliverables and demonstrated relentless passion for helping patients

Managing all relationships in a manner that adheres to all relevant laws, regulations, program-specific operating procedures and industry standards related to access and affordability, including HIPAA and insurance guidelines

Managed through a contact center structure, this role supports outbound and inbound calls to patients, caregivers, specialty pharmacies and healthcare professionals

Performs post benefits investigation calls to patients and/or physicians explaining coverage options and next steps in the access journey

Manages all client inquiries as appropriate, such as specific case statuses

Manages all HCP inquiries, as applicable, pursuant to business rules

All communications with the client's field teams will remain compliant and adhere to ways of working protocols

Manages inbound calls as directed by the program-approved FAQ's

Triage patients to internal or external resources as appropriate

Provides personalized case management to patients and HCP's including outbound communication to HCP's and patients to communicate benefits coverage and next steps in obtaining coverage

Leverages electronic tool to identify benefits and payer coverage; completes manual benefit investigations as needed

Identifies and communicates patients' plan benefit coverage including the need for prior auth, appeal, tier exception, and/or formulary exclusions

Uses electronic resources to obtain benefit coverage outcome and if needed ,outbound call to payers and healthcare providers to follow up on proper submission/or outcome

Compassionately deliver an exceptional experience to many patients per day always remembering that every prescription or document belongs to a real person who is looking for thorough efficient management of their records

Adjust your approach to their needs by communicating clearly, focusing on the accuracy of the details of their medical records and your mastery of the program requirements, and ensuring their prescriptions or cases are handled timely

Reporting of Adverse Events/Product Complaint inquiries received in accordance with SOP and good manufacturer practices

Effectively uses internal technology platform to complete claims processing and keep workflows moving

Communicate with key medical practice accounts, sales representatives regarding the status of cases

Provide consultative services where issues arise on how obstacles can be overcome to get patient on paid therapy

Payer benefits experience, reimbursement, or prior authorization experience required

Must be available for an 8-hour shift between 8:00 AM – 8:00 PM

BENEFITS:

Toll Reimbursement Program (valued at $678.60/annually)

Company paid Short-term Disability (STD)

Increased competitive 401(k) company match up to 4%

Affordable Medical, Dental, and Vision benefits

Concierge Medical Clinic free of cost for those enrolled

Wellness discounts of up to $260 per year for participation in wellness program

Annual HSA employer contribution

Company paid and voluntary Life Insurance options

Voluntary Life, AD&D and Long-Term Disability Insurances

Paid Parental Leave of Absence

Wellness and Employee Assistance Programs

PTO benefits, flex days and paid holidays

Employee Referral Program

Ambassador Program

Tuition reimbursement program up to $5,000 per year

About TEKsystems:

We're partners in transformation. We help clients activate ideas and solutions to take advantage of a new world of opportunity. We are a team of 80,000 strong, working with over 6,000 clients, including 80% of the Fortune 500, across North America, Europe and Asia. As an industry leader in Full-Stack Technology Services, Talent Services, and real-world application, we work with progressive leaders to drive change. That's the power of true partnership. TEKsystems is an Allegis Group company. The company is an equal opportunity employer and will consider all applications without regards to race, sex, age, color, religion, national origin, veteran status, disability, sexual orientation, gender identity, genetic information or any characteristic protected by law.